In the arid expanse of Tharparkar, where drought and malnutrition have long cast a thick shadow, Amina, a mother from a remote village near Mithi, lost her infant daughter in early 2025 to complications from severe acute malnutrition.

“We walked for hours to reach the nearest health facility, but by the time we arrived, it was too late,” she recounted, her voice trembling with grief. “My child was so weak from hunger… we have no clean water, no proper food, and the hospital was short of medicines.”

Amina’s story echoes the ongoing crisis in interior Sindh, where decades of Pakistan People’s Party (PPP) governance have brought claims of progress, yet women and children in rural districts continue to face preventable deaths and suffering.

The PPP, ruling Sindh uninterrupted since 2008, frequently highlights healthcare advancements, particularly through public-private partnerships (PPPs). In late 2025, PPP Chairman Bilawal Bhutto Zardari inaugurated major facilities like the expanded Indus University Hospital in Karachi, claiming free, world-class care and crediting the 18th Amendment for substantial investments. He stated that Sindh now offers “the best healthcare facilities,” with child mortality declining compared to pre-PPP eras, and initiatives like emergency paediatric rooms in all districts via partnerships with the ChildLife Foundation. Expansions in cardiac care at NICVD, paediatric services at NICH, and networks like SIUT and Indus Hospital aim to reach underserved areas, including interior Sindh.

Despite these claims, on-ground realities in districts like Tharparkar, Thatta, and Umarkot reveal a stark divide. Recent data indicate that maternal mortality in Sindh remains high at around 224 per 100,000 live births (from surveys up to 2019, with national estimates showing gradual decline to 155 nationally in 2024). Rural-urban gaps persist, with home deliveries common in areas like Thatta, where only about 50-60 per cent of births occur in facilities due to distance, poverty, and cultural barriers. Under-five mortality in Sindh has seen some improvement historically (from 93 to 77 per 1,000 live births between 2012 and 2018), but national figures hover around 58-59 per 1,000 in recent estimates, with interior regions lagging due to malnutrition and limited access.

Malnutrition remains a critical driver of child deaths in Tharparkar, where stunting affects over 60pc of children under five, wasting around 33pc, and underweight rates near 60pc (based on older surveys, with no major update since 2018). In 2025, reports highlight ongoing food insecurity affecting 21pc of households, low birth weights from maternal malnutrition, and persistent child deaths linked to anaemia, infections, and poor breastfeeding. Frequent outbreaks of measles, diarrhoea, and respiratory illnesses compound the crisis, exacerbated by climate events like the 2024-2025 floods, which damaged infrastructure and spiked waterborne and vector-borne diseases.

Women and mothers in rural Sindh bear heavy burdens. A pregnant woman from Dadu district, affected by 2024 floods, shared: “The water is still stagnant… my family has malaria, skin infections, and diarrhoea. We can’t reach doctors easily.” In Tharparkar, cultural factors like early marriage, high parity, and limited antenatal care contribute to risks. A 2025 study on community midwives in Thatta noted persistent barriers, including low literacy (17pc among women) and home births (around 40pc), leading to high maternal and neonatal mortality in the district.

Stakeholders express frustration over systemic gaps. Health workers report shortages in remote areas, with patients like those in Ghotki facing mobility restrictions: “We need husbands’ permission to go alone, and transport costs are too high.” NGOs and reports criticise inadequate preventive measures during floods, where stagnant water breeds malaria and dengue, disproportionately affecting children and pregnant women. While PPP initiatives like Lady Health Workers and vaccination drives offer some outreach, penetration in interior regions remains weak, with critics arguing that urban-focused expansions (e.g., in Karachi, Larkana) do not sufficiently address rural disparities.

As climate threats intensify — floods in 2024-2025 displaced thousands and damaged facilities — the contrast between government claims and rural realities grows sharper. Bilawal Bhutto Zardari has reaffirmed commitments to extend services to every district, but stories like Amina’s underscore the urgency for tangible action: improved rural infrastructure, better staffing, nutrition programs, and equitable access. Without accelerated efforts, the healthcare abyss in interior Sindh will continue claiming lives, turning promises of justice into echoes of neglect.